Internet Banking Enrollment Form

Please Complete, Sign and Print this form, then bring the form to any of our New Account representatives to receive your Login ID and Password.
* Indicates a Required Field  
* First Name
...Middle Name
* Last Name
* Mailing Address
...Suite, Floor, Apt#
* City
* Zip Code
* E-mail Address
* Social Security Number
* Daytime Phone
* Home Phone
* Mothers Maiden Name
* Checking or Savings Account Number
* Account Type (DO NOT change. Checking is the only valid option)
* Security question of your choice e.g. My pet's name is ...
* Security Answer e.g. Spot
* Do you want to subscribe to Bill Pay services?
* Password (enter your current First Info Line password. If you do not know what it is, call 580-772-5574 during regular banking hours)